DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20213485

Using different surgical techniques and ideas to reduce post-operative adhesion formation: a systematic review and meta-analysis

Rekha Rani, Shikha Singh, Urvashi ., Ruchika Garg

Abstract


Adhesion development is the most common sequelae of intra-abdominal and pelvic surgery. Using a good surgical technique is advocated as a first step in preventing adhesions. However, the evidence for different surgical techniques to reduce adhesion formation needs confirmation. This review contributed to the growing knowledge pool by elucidating factors that potentially predispose to the development of adhesions. A literature search was performed using the PubMed database for all relevant English language articles and were reviewed with particular attention to predisposing factors to post-operative adhesion development. In addition, the reference lists of each article were reviewed to identify additional relevant articles. Various factors have been shown to directly increase the risk of post-operative adhesion development; namely, certain genetic polymorphisms in the interleukin-1 receptor antagonist, increased estrogen exposure, and endometriosis. There were 28 papers with 27 studies included for a systematic review. Of these, 17 studies were eligible for meta-analysis and 11 for qualitative assessment only. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery (relative risk (RR): 0.14; 95% confidence interval (CI): 0.03-0.61) and when the peritoneum was not closed (RR: 0.36; 95% CI: 0.21-0.63). None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes, small bowel obstruction and infertility.


Keywords


Tissue adhesions, Laparoscopy, Peritoneal closure, Infertility, Small bowel obstruction

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References


Milingos S, Kallipolitis G, Loutradis D, Liapi A, Mavrommatis K, Drakakis P, et al. Adhesions: laparoscopic surgery versus laparotomy. Ann N Y Acad Sci.2000;900:272-85.

Swank DJ, Erp WFV, Driel OJRV, Hop WC, Bonjer HJ, Jeekel H. A prospective analysis of predictive factors on the results of laparoscopic adhesiolysis in patients with chronic abdominal pain. Lancet. 2003;361(9365):1247-51.

Broek RPT, Schreinemacher MH, Jilesen AP, Bleichrodt RP, Goor HV. Enterotomy risk in abdominal wall repair: a prospective study. Ann Surg. 2012;256(2):280-7.

Zerega GSD. The cause and prevention of postsurgical adhesions: a contemporary update. Prog Clin Biol Res. 1993;381:1-18.

Taskin O, Sadik S, Onoglu A, Gokdeniz R, Yilmaz I, Burak F, et al. Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease. J Am Assoc Gynecol Laparosc. 1999;6:159-63.

Pellicano M, Bramante S, Cirillo D, Palomba S, Bifulco G, Zullo F, et al. Effectiveness of auto cross linked hyaluronic acid gel after laparoscopic myomectomy in infertile patients: a prospective, randomized, controlled study. Fertil Steril. 2003;80(2):441-4.

Diamond MP, Wexner SD, diZereg GS, Korell M, Zmora O, Goor HV, et al. Adhesion prevention and reduction: current status and future recommendations of a multinational interdisciplinary consensus conference. Surg Innov. 2010;17:183-8.

Lundorff P, Hahlin M, Kallfelt B, Thorburn J, Lindblom B. Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. Fertil Steril. 1991;55(5):911-5.

Metwally M, Watson A, Lilford R, Vandekerckhove P. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2006;2:001298.

Ahmad G, Duffy JM, Farquhar C, Vail A, Vandekerckhove P, Watson A, et al. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2008;2:000475.

Marana R, Rizzi M, Muzii L, Catalano GF, Caruana P, Mancuso S. Correlation between the American Fertility Society classifications of adnexal adhesions and distal tubal occlusion, salpingoscopy, and reproductive outcome in tubal surgery. Fertil Steril. 1995;64:924-9.

Nappi C, DiSpiezio SA, Greco E, Guida M, Bettocchi S, Bifulco G. Prevention of adhesions in gynaecological endoscopy. Hum Reprod Update. 2007;13(4):379-94.

Weerawetwat W, Buranawanich S, Kanawong M. Closure vs non-closure of the visceral and parietal peritoneum at cesarean delivery: 16 year study. J Med Assoc Thai. 2004;87(9):1007-11.

Komoto Y, Shimoya K, Shimizu T, Kimura T, Hayashi S, Temma-Asano K, et al. Prospective study of non-closure or closure of the peritoneum at cesarean delivery in 124 women: impact of prior peritoneal closure at primary cesarean on the interval time between first cesarean section and the next pregnancy and significant adhesion at second caesarean. J Obstet Gynaecol Res. 2006;32(4):396-402.

Zareian Z, Zareian P. Non-closure versus closure of peritoneum during cesarean section: a randomized study. Eur J Obstet Gynecol Reprod Biol. 2006;128(1-2):267-9.

Nabhan AF. Long-term outcomes of two different surgical techniques for caesarean. Int J Gynaecol Obstet. 2008;100(1):69-75.

Kapustian V, Anteby EY, Gdalevich M, Shenhav S, Lavie O, Gemer O. Effect of closure versus nonclosure of peritoneum at cesarean section on adhesions: a prospective randomized study. Am J Obstet Gynecol. 2012;206(1):56.

Fazio VW, Cohen Z, Fleshman JW, vanGoor H, Bauer JJ, Wolff BG, et al. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. 2006;49(1):1-11.

Kadanali S, Erten O, Kucukozkan T. Pelvic and periaortic pertioneal closure or non-closure at lymphadenectomy in ovarian cancer: effects on morbidity and adhesion formation. Eur J Surg Oncol. 1996;22(3):282-5.

Bamigboye AA, Hofmeyr GJ. Local anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief. Cochrane Database Syst Rev. 2009;3:006954.

CAESAR study collaborative group. Caesarean section surgical techniques: a randomised factorial trial (CAESAR). BJOG. 2010;117(11):1366-76.

Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective COHORT study. Lancet. 1999;353(9163):1476-80.

McFadden PM, Peacock EE. Preperitoneal abdominal wound repair: incidence of dehiscence. Am J Surg. 1983;145(2):213-4.

Gilbert JM, Ellis H, Foweraker S. Peritoneal closure after lateral paramedian incision. Br J Surg. 1987;74(2):113-5.

Hugh TB, Nankivell C, Meagher AP, Li B. Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds? World J Surg. 1990;14(2):231-3.

Than GN, Arany AA, Schunk E, Vizer M, Krommer KF. Closure or non-closure of visceral peritoneums after abdominal hysterectomies and Wertheim-Meigs radical abdominal hysterectomies. Acta Chir Hung. 1994;34:79-86.

Lipscomb GH, Ling FW, Stovall TG, Summitt RL. Peritoneal closure at vaginal hysterectomy: a reassessment. Obstet Gynecol. 1996;87(1):40-3.

Binda MM, Molinas CR, Koninckx PR. Reactive oxygen species and adhesion formation: clinical implications in adhesion prevention. Hum Reprod. 2003;18(12):2503-7.

Brokelman WJ, Holmdahl L, Bergstrom M, Falk P, Klinkenbijl JH, Reijnen MM. Peritoneal fibrinolytic response to various aspects of laparoscopic surgery: a randomized trial. J Surg Res. 2006;136:309-13.

Binnebosel M, Klink CD, Grommes J, Jansen M, Neumann UP, Junge K. Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models. Langenbecks Arch Surg. 2011;396:133-7.

Kirchhoff S, Ladurner R, Kirchhoff C, Mussack T, Reiser MF, Lienemann A. Detection of recurrent hernia and intraabdominal adhesions following incisional hernia repair: a functional cine MRI-study. Abdom Imaging. 2010;35(2):224-31.

Lienemann A, Sprenger D, Steitz HO, Korell M, Reiser M. Detection and mapping of intraabdominal adhesions by using functional cine MR imaging: preliminary results. Radiology. 2000;217(2):421-5.

Diamond MP. Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study. Seprafilm Adhesion study group. Fertil Steril. 1996;66(6):904-10.

diZerega GS, Verco SJ, Young P, Kettel M, Kobak W, Martin D, et al. A randomized, controlled pilot study of the safety and efficacy of 4% icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery. Hum Reprod. 2002;17(4):1031-8.

Chen MD, Teigen GA, Reynolds HT, Johnson PR, Fowler JM. Laparoscopy versus laparotomy: an evaluation of adhesion formation after pelvic and paraaortic lymphadenectomy in a porcine model. Am J Obstet Gynecol. 1998;178(3):499-503.

diZerega GS. The cause and prevention of postsurgical adhesions: a contemporary update. Prog Clin Biol Res. 1993;381:1-18.

Duffy DM, diZerega GS. Is peritoneal closure necessary? Obstet Gynecol Surv. 1994;49(12):817-22.

Duron JJ. Postoperative intraperitoneal adhesion pathophysiology. Colorectal Dis. 2007;9(2):14-24.

Ellis H, Heddle R. Does the peritoneum need to be closed at laparotomy? Br J Surg. 1977;64(10):733-6.

Eshuis EJ, Slors JF, Stokkers PC, Sprangers MA, Ubbink DT, Cuesta MA, et al. Long-term outcomes following laparoscopically assisted versus open ileocolic resection for Crohn's disease. Br J Surg. 2010;97:563-8.

Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203(2):170-6.

Franchi M, Ghezzi F, Zanaboni F, Scarabelli C, Beretta P, Donadello N. Nonclosure of peritoneum at radical abdominal hysterectomy and pelvic node dissection: a randomized study. Obstet Gynecol. 1997;90:622-7.

Fujishita A, Masuzaki H, Khan KN, Kitajima M, Hiraki K, Ishimaru T. Laparoscopic salpingotomy for tubal pregnancy: comparison of linear salpingotomy with and without suturing Hum Reprod 2004;19(5):1195-200.

Godinjak Z, Idrizbegovic E. Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in infertile women? Bosn J Basic Med Sci. 2008;8(1):44-7.

Gurgan T, Kisnisci H, Yarali H, Develioglu O, Zeyneloglu H, Aksu T. Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease. Fertil Steril. 1991;56:1176-8.

Gurgan T, Urman B, Aksu T, Yarali H, Develioglu O, Kisnisci HA. The effect of short-interval laparoscopic lysis of adhesions on pregnancy rates following Nd-YAG laser photocoagulation of polycystic ovaries. Obstet Gynecol. 1992;80(1):45-7.

Hammoud AO, Gibson M, Stanford J, White G, Carrell DT, Peterson M. In vitro fertilization availability and utilization in the United States: a study of demographic, social, and economic factors. Fertil Steril. 2009;91(5):1630-5.

Hiki N, Shimizu N, Yamaguchi H, Imamura K, Kami K, Kubota K, et al. Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg. 2006;93:195-204.

Ivarsson ML, Bergstrom M, Eriksson E, Risberg B, Holmdahl L. Tissue markers as predictors of postoperative adhesions. Br J Surg. 1998;85(11):1549-54.

Kapur ML, Daneswar A, Chopra P. Evaluation of peritoneal closure at laparotomy. Am J Surg. 1979;137(5):650-2.

Krahenbuhl L, Schafer M, Kuzinkovas V, Renzulli P, Baer HU, Buchler MW. Experimental study of adhesion formation in open and laparoscopic fundoplication. Br J Surg. 1998;85:826-30.

Kyzer S, Bayer I, Turani H, Chaimoff C. The influence of peritoneal closure on formation of intraperitoneal adhesions: an experimental study. Int J Tissue React. 1986;8(5):355-9.

Levrant SG, Bieber EJ, Barnes RB. Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc. 1997;4(3):353-6.

Lim R, Morrill JM, Lynch RC, Reed KL, Gower AC, Leeman SE, et al. Practical limitations of bioresorbable membranes in the prevention of intra-abdominal adhesions. J Gastrointest Surg. 2009;13(1):35-41.

Lower AM, Hawthorn RJ, Ellis H, O'Brien F, Buchan S, Crowe AM. The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the surgical and clinical adhesions research study. BJOG. 2000;107(7):855-62.

Lower AM, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD, et al. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients. Hum Reprod. 2004;19(8):1877-85.

Luijendijk RW, Wauters CC, Hop WC, Duron JJ, Pailler JL, Camprodon BR, et al. Foreign material in postoperative adhesions. Ann Surg. 1996;223(3):242-8.

Lundorff P, Thorburn J, Lindblom B. Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial. Fertil Steril. 1992;57(5):998-1002.

Lyell DJ, Caughey AB, Hu E, Daniels K. Peritoneal closure at primary cesarean delivery and adhesions. Obstet Gynecol. 2005;106(2):275-80.

Malvasi A, Tinelli A, Farine D, Rahimi S, Cavallotti C, Vergara D, et al. Effects of visceral peritoneal closure on scar formation at cesarean delivery. Int J Gynaecol Obstet. 2009;105:131-5.

Marana R, Luciano AA, Muzii L, Marendino VE, Mancuso S. Laparoscopy versus laparotomy for ovarian conservative surgery: a randomized trial in the rabbit model. Am J Obstet Gynecol. 1994;171:861-4.

Mercorio F, Mercorio A, DiSpiezio SA, Barba GV, Pellicano M, Nappi C. Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second-look minilaparoscopy. Fertil Steril. 2008;89(5):1229-33.

Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60(5):571-607.

Nakagawa K, Ohgi S, Horikawa T, Kojima R, Ito M, Saito H. Laparoscopy should be strongly considered for women with unexplained infertility. J Obstet Gynaecol Res. 2007;33(5):665-70.

National Institute of Clinical Excellence. Caesarean section. Clinical guidelines 2004, guideline no. 13. London: RCOG Press; 2011.

Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Hon SS. Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum. 2009;52(4):558-66.

Nieuwenhuijzen M, Reijnen MM, Kuijpers JH, Goor HV. Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review. Br J Surg. 1998;85(9):1242-5.

Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, et al. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum. 2001;44(6):822-9.

Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, et al. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis. 2005;7(6):551-8.

Parulkar BG, Supe AN, Vora IM, Mathur SK. Effects of experimental non-closure of peritoneum on development of suture line adhesions and wound strength in dogs. Indian J Gastroenterol. 1986;5(4):251-3.

Pellicano M, Guida M, Bramante S, Acunzo G, DiSpiezio SA, Tommaselli GA, et al. Reproductive outcome after autocrosslinked hyaluronic acid gel application in infertile patients who underwent laparoscopic myomectomy. PLoS One. 2015;10(5):0125610.

Pellicano M, Bramante S, Guida M, Bifulco G, DiSpiezio SA, Cirillo D, et al. Ovarian endometrioma: postoperative adhesions following bipolar coagulation and suture. Fertil Steril. 2008;89(4):796-9.

Polymeneas G, Theodosopoulos T, Stamatiadis A, Kourias E. A comparative study of postoperative adhesion formation after laparoscopic vs open cholecystectomy. Surg Endosc. 2001;15(1):41-3.

Roy KK, Baruah J, Moda N, Kumar S. Evaluation of unilateral versus bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome. Arch Gynecol Obstet. 2009;280(4):573-8.

Royal College of Obstetricians and Gynecologists, 2002 Peritoneal Closure. Clinical Green Top Guidelines, Guideline No. 15

Sawada T, Nishizawa H, Nishio E, Kadowaki M. Postoperative adhesion prevention with an oxidized regenerated cellulose adhesion barrier in infertile women 195. J Reprod Med. 2000;45(5):387-9.

Schreinemacher MH, Broek RP, Bakkum EA, Goor HV, Bouvy ND. Adhesion awareness: a national survey of surgeons. World J Surg. 2010;34(12):2805-12.

Sharma M, Kriplani A, Agarwal N. Laparoscopic bipolar versus unipolar ovarian drilling in infertile women with resistant polycystic ovarian syndrome: a pilot study. J Gynecol Surg. 2006;22:105-11.

Stocchi L, Milsom JW, Fazio VW. Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: follow-up of a prospective randomized trial. Surgery. 2008;144(4):622-7.

Takahashi K, Kita N, Kimura F, Fujiwara M, Noda Y, Miyazaki K. A comparative study using early second-look laparoscopic evaluation of postoperative adhesion formation between two surgical procedures for polycystic ovarian syndrome. Obstet Gynecol Surv. 2007;62:443-5.

Talwar S, Laddha BL, Jain S, Prasad P. Choice of incision in surgical management of small bowel perforations in enteric fever. Trop Gastroenterol. 1997;18(2):78-9.

Taylor GW, Jayne DG, Brown SR, Thorpe H, Brown JM, Dewberry SC, et al. Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial. Br J Surg. 2010;97:70-8.

Broek RP, Wilbers J, Goor HV. Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection. Surg Endosc. 2011;25(6):1827-34.

Tulandi T. Salpingo-ovariolysis: a comparison between laser surgery and electrosurgery. Fertil Steril. 1986;45(4):489-91.

Tulandi T, Al-Jaroudi D. Nonclosure of peritoneum: a reappraisal. Am J Obstet Gynecol. 2003;189(2):609-12.

Tulandi T, Guralnick M. Treatment of tubal ectopic pregnancy by salpingotomy with or without tubal suturing and salpingectomy. Fertil Steril. 1991;55(1):53-5.

Krabben AAVD, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Goor HV. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87:467-71.

Goor HV. Consequences and complications of peritoneal adhesions. Colorectal Dis. 2007;9(2):25-34.

Wong SS, Wilczynski NL, Haynes RB. Comparison of top-performing search strategies for detecting clinically sound treatment studies and systematic reviews in MEDLINE and EMBASE. J Med Libr Assoc. 2006;94(4):451-5.